MEDICARE: DR. BRANDON DISBROW DENIKE DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	16189	AR

General Provider Information

NPI Number	:	1932686722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON DISBROW DENIKE DC

Provider Business Mailing Address
First Line	:	212 S BROADWAY ST
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-3130
Country	:	US
Telephone Number	:	479-524-5103
Fax Number	:	479-524-9638

Provider Business Practice Location Address
First Line	:	212 S BROADWAY ST
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-3130
Country	:	US
Telephone Number	:	479-524-5103
Fax Number	:	479-524-9638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	07/24/2018

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